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Anatomy - Resection of an infrarenal abdominal aortic aneurysm and tube graft interposition

vascular surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Abdominal aorta

    Abdominal aorta
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    Origin

    • It is the continuation of the thoracic aorta after it passes through the aortic hiatus of the diaphragm at the level of the 12th thoracic vertebra (T12)

    Course

    • Retroperitoneal
    • Left of the median plane, anterior to the spine
    • At the level of the umbilicus/4th lumbar vertebra (L4) it divides (aortic bifurcation) into the common iliac arteries

    Branches from cranial to caudal

    • Inferior phrenic arteries
    • Coeliac trunk
    • Middle suprarenal artery (left and right)
    • Superior mesenteric artery
    • Renal artery (left and right)
    • Ovarian / testicular artery (left and right)
    • Lumbar arteries
    • Inferior mesenteric artery
    • Median sacral artery

    Distribution

    • Paired branches: abdominal wall, paired retroperitoneal organs, gonads
    • Unpaired branches: spleen, unpaired digestive organs

  2. Paired branches of the abdominal aorta

    Main branches

    Course

    Branches and their distribution

    Inferior phrenic artery

    • Courses craniad on the inferior aspect of the diaphragm toward its dome
    • Reticular division into several terminal branches

    Superior suprarenal artery: adrenal gland

    Terminal branches: inferior aspect of the diaphragm

    Middle suprarenal artery

    • Courses laterad to the adrenal glands

    Terminal branches: adrenal glands

    Renal artery

    • Arises at around the level of the first / second lumbar vertebra (L1-2)
    • Right renal artery: courses posterior to the inferior vena cava and head of pancreas to the right kidney
    • Left renal artery: courses posterior to the body of pancreas to the left kidney

    Inferior suprarenal artery: adrenal gland

    Ovarian artery,

    Testicular artery

    • Arises inferior to the renal arteries / second lumbar vertebra (L2) from the anterior aspect of the aorta
    • Crosses over the psoas muscle, ureter and external iliac arteries to the suspensory ligament of the ovary / deep inguinal ring of the inguinal canal and the testes

    Ovarian arteries: ovaries, parts of the uterine tube,

    Testicular arteries: testes, epididymides

    Lumbar arteries (4 bilaterally)

    • Run laterad posterior to the psoas muscle over the 1st to 4th lumbar vertebra (L1–4)
    • Anastomose with the arteries of the anterior abdominal wall (superior and inferior epigastric arteries, iliolumbar artery, deep circumflex iliac artery)

    Spinal branches: spinal canal

    Terminal branches: abdominal wall, muscles of the back

Unpaired branches of the abdominal aorta

All unpaired branches of the abdominal aorta form anastomoses maintaining organ perfusion via colla

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